Despite robust evidence that medications reduce secondary fracture risk among women and progressive national attention to rewarding quality of care, only about 1 in 5 older women with prior fractures receive either osteoporosis evaluation or treatment. Discovering and rigorously testing novel methods to implement evidence has become an important area of research that is featured in this proposal entitled "Activating Patients to Reduce OsteoPorosiS (APROPOS)." The Global Longitudinal Registry of Osteoporosis in Women (GLOW) is an international prospective, longitudinal, observational study of over 60,000 women 55 years of age and older, which provides the patient base for this timely study. Within GLOW there are 3,442 women in the U.S. with fractures reported on annual surveys who are not using anti-osteoporosis therapies. Among these high risk women, we will develop and test a tailored evidence implementation intervention with Specific Aims of: 1) Use formative analysis to develop a video-based direct-to-patient intervention, designed to provide personalized feedback regarding patients'risk of subsequent fractures, customized information regarding osteoporosis care, and messaging to activate them to become more proactive in improving doctor-patient communication. This novel content will use story-telling delivered via the Internet and DVDs. The content will be uniquely tailored to each person based on barriers to care, fracture risk and race/ethnicity. 2) Conduct a controlled, cluster-randomized trial of this direct-to-patient intervention among these GLOW participants (unit of randomization, prescribing physicians: unit of analysis, GLOW participants) to determine differences in post-intervention rates of osteoporosis care between two randomization arms. We hypothesize that participants (all at high risk for future fracture) randomized to the intervention arm, compared to those randomized to a control arm, will receive more osteoporosis care at 6 months post-intervention, as evidenced by higher rates of: (H1) Prescription osteoporosis therapies, (H2) Non- prescription therapy with calcium and vitamin D, and (H3) Bone mineral density (BMD) testing Exploratory analyses will examine whether the intervention leads to changes in osteoporosis-related health beliefs, greater levels of doctor-patient communication, and changes in possible concerns about osteoporosis medication safety and efficacy. This timely cluster randomized controlled trial, built upon a successful and well established cohort, provides a unique and timely opportunity to conduct this study on a national scale, in real world settings. Supported by our AHRQ funded Center for Education and Research on Therapeutics (CERTs), there is an ever-increasing movement by UAB and its collaborators to expand our substantial evidence implementation expertise towards identifying low-cost novel strategies that translate research into practice. If proven effective, this "patient activation" approach will have high applicability to evidence implementation in many other health care settings, maximizing its public health impact. PUBLIC HEALTH RELEVANCE: The majority of patients who have experienced a fracture receive neither testing nor treatment for osteoporosis. The Global Longitudinal Registry of Osteoporosis in Women (GLOW) will be used to conduct a novel evidence implementation study aimed at improving osteoporosis health care quality by activating patients to more meaningfully interact with their health care providers leading to greater rates of appropriate osteoporosis care.